Individual
JOEL R. WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
75 SPY ROCK LOOP ROAD, LOOKOUT, WV 25868
(304) 574-2076
(304) 574-1068
Mailing address
PO BOX 337, SCARBRO, WV 25917-0337
(304) 469-2905
(304) 465-1518
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2353
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0136147000
—
WV
05
—
0357662
—
OH
Enumeration date
04/08/2006
Last updated
10/26/2016
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